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Innovative Perfusion Technology Advances Surgical Training

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During a procedure, surgeons operate with precision, even as blood continues to circulate throughout the body. Organ damage can occur without adequate blood flow – or perfusion – to vital organs. For this reason, surgeons in training must learn how to operate on perfused tissue. Today, the Department of Surgery at Washington University School of Medicine in St. Louis is utilizing innovative applications of machine perfusion technology to further enhance the training experience of future surgical leaders.

A large part of surgical residents’ training takes place in the operating room, where they observe and assist with cases, eventually performing operations under supervision as they develop autonomy. However, simulation plays an increasingly important role in surgical training. Simulation training is the process of developing and refining surgical skills in a non-clinical setting, where no patients are present, and the focus is entirely on education.

Washington University is one of the only academic surgical centers in the country utilizing a novel system of cadaveric perfusion for advanced simulation training and research opportunities. Cadaveric perfusion uses perfusion technology to circulate a bloodlike, saline-based fluid through areas of a cadaver, simulating the effect of operating on a patient with healthy blood flow.

“There are many remarkable simulation models available to trainees for practicing nearly every surgical skill and operation, but in certain cases nothing can substitute for the experience of working with perfused tissue,” says John A. Olson Jr., MD, PhD, the William K. Bixby Professor and chair of the Department of Surgery. “This experience of training with perfused cadavers helps prepare young surgeons for situations when a patient comes to us with a traumatic injury or critical illness, and we must be ready to provide the care they need. When our residents finish their surgical training, they’re able to provide the very best care to patients, thanks to the high level of operative and simulation experience they receive at Washington University.”

Training with perfused cadavers takes place in the Washington University Institute for Surgical Education (WISE), which was among the first surgical simulation centers of its kind in the U.S. when it was initially introduced in 2001. Since that time, WISE has grown to over 3,400 square feet of education space, been certified as a Level 1 Comprehensive American College of Surgeons Accredited Education Institute (ACS-AEI), introduced an ACS-AEI education fellowship for surgical residents interested in investigating advances in surgical training and become an official training center for robotically-assisted surgery. Each year, WISE hosts over 1,400 events and serves over 4,500 learners from across the nation.

“It is no longer acceptable to do a procedure for the first time on a patient. That’s where simulation comes in,” says Director of WISE Michael Awad, MD, PhD, MHPE, who is president of the Association for Surgical Education. “In the operating room, the focus has to be on the patient. In the simulation center, education and training are at the forefront.”

Other areas of WISE curricula include skills courses for suturing, knot tying, central line placement, laparoscopy, endoscopy, robotics and open surgery, among other skills courses. Trainees begin on low-fidelity simulators, such as foam or rubber, and advance to more anatomically realistic models as they progress through their training.

More complex or dynamic types of care, such as treating shock and trauma, require a higher level of fidelity. In other words, the simulated environment must account for blood loss and other critical problems not easily reproduced with materials such as rubber or plastic. In fact, studies of cadaveric perfusion show that trainees report improved anatomical realism and a higher degree of readiness for actual clinical cases after training with perfuse tissue.

Although cadaveric perfusion has many benefits for surgical trainees, it is a costly process. Few institutions have the resources—financial and otherwise—to make this advanced simulation training available to their surgical residents. Washington University is able to provide this valuable training experience thanks, to generous gifts from donors, including the Felman family, whose contribution funded cadaveric perfusion training at WISE. Donations to the Department of Surgery make it possible for Washington University to continue training surgeons who will provide the highest level of care to patients for decades to come.

Body donation, which makes this valuable simulation experience possible, directly contributes to the advancement of medical education and biomedical research. These anatomical donations are critical to helping medical students, resident physicians, clinical fellows and other trainees gain in-depth understanding of the human anatomy, an important foundation for the delivery of excellent patient care. Donors also empower vital biomedical research aimed at improving human health. Learn more about the Body Donor Program at Washington University School of Medicine in St. Louis.

The significance of working with cadaver models is not lost on the faculty, trainees and staff involved.

“A person made the decision to make a donation to science. That donation is furthering our understanding of and ability to treat some of the most dire surgical problems facing us today,” says Olson. “Before we begin any procedure, we take a time out to honor the life of the person who made that gift. Everyone in the room recognizes the importance of this moment and the impact their donation will have on the future of patient care, not only in St. Louis, but for patients around the world.”